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General NPI Number Information
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NPI Number | 1932193869
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Entity Type | Individual
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Provider Name | DALLIN C YOUNG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1186 EASTLAND DR N SUITE B
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City | TWIN FALLS
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State | ID
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Zip | 83301-8973
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Country | US
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Telephone | 208-733-9331
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Fax | 208-732-1222
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Provider Business Mailing Address
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Address Line | PO BOX 5881
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City | TWIN FALLS
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State | ID
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Zip | 83303-5881
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Country | US
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Telephone | 208-733-9331
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Fax | 208-732-1222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D-3874-PD
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License Number State | ID
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